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Context: Historically, Canadians experience long wait times for specialist referrals. During the COVID-19 pandemic, many specialist services were suspended to reduce virus transmission and redeploy physicians. Little has been reported on family physicians' (FPs') perspectives and experiences accessing specialists during the pandemic and implications for practice. Objective: To understand FPs' experiences accessing specialists during the COVID-19 pandemic. Study design and analysis: A qualitative, multiple case study was conducted. Relevant data (i.e., pertaining to specialists) were thematically analyzed. Setting: Four Canadian jurisdictions (Vancouver Coastal Health region, British Columbia; Southwestern Ontario; the province of Nova Scotia; and Eastern Health region of Newfoundland and Labrador). Population studied: FPs who were practicing in Canada during the COVID-19 pandemic. Instrument: Semi-structured exploratory qualitative interviews. Outcome measures: Perspectives from FPs on accessing specialists during the COVID-19 pandemic. Results: Thirty-nine of 68 FP interviewees described experiences accessing specialists during the pandemic. Findings were organized according to the CanMEDS competency framework. This framework describes competencies held by FPs and, by organizing identified themes by this framework, we illustrate how FPs applied these competencies during the pandemic. Themes included: 1) collaborator: barriers and enabler to accessing specialists, opportunities for greater collaboration, and conflict between specialists and FPs; 2) medical expert: working beyond typical scope to manage patients in lieu of specialist appointments; 3) health advocate: identifying patient needs and advocating for them to be seen by specialists; 4) communicator: explaining changes to patients and managing patient frustration; 5) scholar: integrating best practices and contributing to research; 6) professional: applying best practices and identifying issues of FP wellness; 7) leader: suggesting improvements to challenges exacerbated by the pandemic. Conclusion: The COVID-19 pandemic exacerbated existing challenges in primary healthcare. Although there were challenges associated with the lack of access to specialists, and FPs took on additional work to address access challenges, there were also opportunities for greater collaboration and innovation., Presenters Emily Gard Marshall, PhD, MSc, Richard Buote, PhD, Lauren Moritz, BA, MA, Julia Lukewich, PhD, RN, Maria Mathews, PhD, Lindsay Hedden, PhD, [...]

Context: It is becoming more difficult to find a family physician in Canada. This has led to speculation that new family physicians may be to blame because they are more likely to provide lower service volume and less likely to provide longitudinal primary care. Objective: To investigate the impact of graduation cohort on family physician practice volume and continuity of care over two decades. Study Design and Analysis: Retrospective-cohort of family physicians from 1997/98 to 2017/18. Median polish analysis of patient contacts and physician-level continuity was completed to isolate years in practice, period, and cohort effects. Dataset: Administrative health and physician claims data were collected in British Columbia, Manitoba, Ontario, and Nova Scotia, Canada. Databases included registry files from provincial regulatory colleges, physician billing information, and patient registration files for provincial insurers. Population Studied: All physicians registered with their respective provincial regulatory colleges with a medical specialty of family practice and/or billed the provincial health insurance system for patient care as FPs. Outcome Measures: Patient contacts (count of unique patient-physician day combinations) and physician-level continuity (proportion of total annual contacts--excluding ED visits--that all patients seen by an FP had with that FP). Results: Median patient contacts per provider fell over time in the four provinces examined. In all provinces, median contacts increased with years in practice until mid-to- late-career and declined into end-of-career. We found no relationship between graduation cohort and practice volume or FP-level continuity. Conclusions: Declines in service volume were observed in all provinces, with expected trajectories of service volume and continuity over a FP's career. We found no generational differences in FP practice. These findings are important for health workforce planning in primary care sectors across the country, and for the general discourse concerning the behaviours and preferences of recent medical graduates. Our findings highlight that intergenerational tension and blame is unfounded and only distracts from important issues in workforce planning in primary care sectors., Presenters David Rudoler, PhD, Agnes Grudniewicz, PhD, Ruth Lavergne, PhD, Emily Gard Marshall, PhD, MSc, Laurie Goldsmith, [...]

Introduction: Health system disruptions, caused by unexpected emergencies such as disease outbreaks, natural disasters, and cybercrimes, impact the delivery of routine preventative care. As comprehensive care providers, family physicians (FPs) devote significant time to prevention. However, without emergency and pandemic plans in place in primary care, FPs face added barriers to prioritizing and sustaining preventative care when health systems are strained, which was evident during the COVID-19 pandemic. This study aims to describe FPs' experiences providing preventative care during the COVID-19 pandemic and their perceptions of the impacts of disrupted preventative care in primary care settings.Methods: Using a qualitative descriptive approach, we conducted semistructured interviews with FPs across 4 provinces in Canada (i.e. Newfoundland and Labrador, Nova Scotia, Ontario, British Columbia) between October 2020 and June 2021 as part of a larger multiple case study. These interviews broadly explored the roles and responsibilities of FPs during the COVID-19 pandemic. Interviews were coded thematically and codes from the larger study were analysed further using an iterative, phased process of thematic analysis.Results: Interviews averaged 58 min in length (range 17-97 min) and FPs had a mean of 16.9 years of experience. We identified 4 major themes from interviews with FPs (n = 68): (i) lack of capacity and coordination across health systems, (ii) patient fear, (iii) impacts on patient care, and (iv) negative impacts on FPs. Physicians voiced concerns with managing patients' prevention needs when testing availability and coordination of services was limited. Early in the pandemic, patients were also missing or postponing their own primary care appointments. Change in the provision and coordination of routine preventative care had negative impacts on both patients and physicians, affecting disease incidence/progression, physician workload, and psychological wellbeing.Conclusion: During the COVID-19 pandemic, upstream care efforts were impacted, and FPs were forced to reduce their provision of preventative care. FPs contribute direct insight to primary care delivery that can support pandemic planning to ensure preventative care is sustained during future emergencies. [ABSTRACT FROM AUTHOR]

Background Access to Primary Care Providers (PCPs) is limited for many Canadians. "Unattached patients" are persons who do not have a PCP. Older adults living with dementia may face greater challenges seeking attachment. This study investigated whether older adults living with dementia experience differential wait times for PCPs compared to those without a diagnosis of dementia. Methods This was an observational descriptive study of the centralized wait-list data from the Nova Scotia (NS) Need a Family Practice Registry (NaFPR). Time on provider wait-list by dementia diagnosis and age were compared. Number of days on the registry across these measures was estimated. Multivariable proportional hazards regression was used to compare hazards of remaining on the registry over time. Results Unattached older adults living with dementia were on the NaFPR for less time compared to those without dementia (381.4 vs. 428.8 days, respectively). After adjusting for age, self-reported gender, comorbidity, rurality, income quintiles, and overall deprivation, older adults with dementia had a 1.13-fold (95% CI: 1.04-1.24) increase in the likelihood of leaving the NaFPR. Potential contributors to this small difference could be placement in Long Term Care (LTC) and subsequent facility PCP attachment. Conclusions Analysis of the NaFPR exhibited similarly time to PCP attachment despite a diagnosis of dementia. This represented an effective equality model of health care utilized in NS. Future studies should investigate whether an equity model with priority attachment for vulnerable patients would reduce hospitalization and LTC institutionalization. [ABSTRACT FROM AUTHOR]